Mang Toryo, 56, was a driver, and for over 30 years his colorful jeepney was a familiar presence in the town where he worked and lived. But one morning he did not wake up, and the jeepney was instead driven by a neighbor to rush him to the nearest hospital. The diagnosis, which came too late to save his life, was a heart attack on top of a long-running high blood pressure, also known as uncontrolled hypertension.
His death was a family tragedy and a loss to the community. But what is even more unfortunate is that his story is common in a country where two hypertension-related conditions — heart disease and stroke — are the leading causes of death and illness, and where, per World Health Organization data, 25 percent of adults have high blood pressure. Moreover, poor individuals, like Mang Toryo, are less likely to be able to manage their hypertension. This places them at greater risk of death or permanent disability after a heart attack or stroke than their rich counterparts.
Such inequality is unjust because safe and effective medications for hypertension have been available since the early 1960s. Low-cost preventive measures like exercise and diet changes have likewise been used successfully for a long time. In other words, hypertension is a largely manageable disease that shouldn’t have to lead to death and disability.
What can explain this gap between knowledge, implementation and health outcomes?
Fortunately, the Philippines is the setting for a major new international research project that seeks to answer this question. A team led by Dr. Antonio Dans of the Philippine General Hospital is collaborating with a group of researchers led by Prof. Martin McKee from the London School of Hygiene and Tropical Medicine. This project seeks to better understand the reality of living with high blood pressure for poor Filipinos. People with high blood pressure in some of the poorest areas of the country are being recruited and will be monitored for a year. Researchers will record their experiences of living with high blood pressure, including their encounters with health care providers and their experiences of obtaining and adhering to any prescribed treatments.
Of course, the project is not starting from scratch. We already have some ideas of the challenges that poor individuals face when seeking care for hypertension: Despite the Generics law, the high cost of medicines remains a big impediment, and so does access to outpatient and primary health care facilities. Because hypertension is a chronic disease that requires long-term treatment, most patients are lost to follow up. Importantly, many do not really consider hypertension as necessitating treatment, regarding it as a condition that is “malayo sa bituka (far from the guts).”
The project, however, will strive for a much deeper understanding of how families and individuals deal with such challenges, and any alternative types of care they might seek, by using an ethnographic approach and privileging patient perspectives.
Moreover, on top of the research objectives, the project — funded by the British Wellcome Trust and Newton Fund — also seeks to build capacity in health systems research in the Philippines and ensure that any evidence generated has an impact on health policy in the country. In doing so, the researchers hope to contribute to a robust health research community that is a crucial element in the Department of Health’s longstanding (and rightful) push for universal health care (UHC).
The rationale for this undertaking — and, more broadly, for prioritizing hypertension in research and advocacy — goes beyond health. Internationally, there is now much better recognition of the importance of good health, not just in its own right to prevent unnecessary suffering, but also as a driver of economic growth. Healthy people are more productive, they work for longer hours, and invest in the future. The Philippines’ future economic prospects depend on the good health of its people. But there is clearly much room for improvement, particularly in the management of high blood pressure.
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Gideon Lasco, MD, PhD (incoming faculty, University of the Philippines Diliman-Department of Anthropology) and Benjamin Palafox, MSc (research fellow, London School of Hygiene and Tropical Medicine, University of London) are scholars who engage in health systems research.